By Muhammad S. Feteiha, MD, FACS
For years, surgeons and patients alike have marveled at the improvements in type-2 diabetes within days or weeks of bariatric surgery – specifically, gastric bypass surgery. Until recently, it was assumed that dramatic weight loss and calorie restriction was the reason behind these marvelous results. However, there was a nagging question in all our minds – how did type-2 diabetes go into remission in so many patients within a mere few days or weeks of surgery…often before any significant weight was lost.1It was a question often pondered, but rarely researched – mostly because bariatric surgery was an option limited to the obese population. In other words, it was doing its job.
Today, diabetes is an ever-growing part of society, becoming a leading cause of illness and death in the United States and around the globe. However, gastric bypass remains a procedure limited only to those who are morbidly obese (with a BMI of 40 or over) or those with a BMI of 35 and over with one or more comorbid conditions such as diabetes. In other words, weight is still the primary driver for surgical candidacy.
The result is that while advocacy groups and surgeons alike are recognizing the potential benefits of bariatric surgery for a larger number of less- or non-obese diabetic patients, wider adoption remains challenging.
Sleep apnea describes interrupted sleep caused by partial or complete closure of the airway during sleep. Overweight and obese patients may suffer from mild to significant sleep apnea. Sleep apnea is particularly common obese patients because the excess fat in the back throat is often to blame for the development or worsening of the condition.
Many patients suffering from sleep apnea come to our office for their first consultation complaining of poor sleep, drowsiness during the day and even falling asleep at inopportune or dangerous times. Spouses and significant others typically describe loud snoring from the patient.
It’s a rare but aggressive disease – Gallbladder cancer. Many patients experiencing gallbladder issues are concerned that it may be a contributory risk to gallbladder cancer. The short answer is that gallbladder disease does not typically cause cancer, however extremely large gallstones have been shown to have a correlation with a higher incidence of gallbladder cancer. This is one of the reasons why we suggest not waiting to treat gallbladder disease and gallstones. It is also why we send the excised gallbladder to pathology after surgery – Just to make sure.
Being that the risk of gallbladder cancer is so low, it is important to cover the most common and problematic issues associated with gallbladder disease:
Many of our patients are confused when they find out that preoperative psychological testing and evaluation is a required part of our bariatric surgery program. You may be one of them. So, in this blog post, we want to explore why these preoperative tests are necessary and why you shouldn’t think that we think you’re crazy.
A preoperative psych evaluation is not only a required part of the bariatric surgery program here at Advanced Surgical Associates, but it is also a required prerequisite of insurance coverage for weight loss surgery. This is for good reason and a very simple reason – weight loss surgery will change your life in many ways that you may or may not expect. Let’s explore
There isn’t a dieter in the world that hasn’t experienced a weight loss plateau during their lifestyle change. This is no different for weight loss surgery patients. Weight loss plateaus usually occur a few months after surgery and can be especially frustrating for weight loss surgery patients because they will have seen incredible weight loss results over the past several months – then the number on the scale just stalls. While weight loss plateaus can be upsetting, they are also an important part of the postoperative learning cycle. Let’s explore plateau’s and how to manage them:
So, why do we plateau after such amazing weight loss?
Weight loss pills have always been part of a dieter’s consciousness. After trying diet, exercise, fad diets and more, many patients believe that medication or supplements to lose weight are a viable option. However, these drugs, while benefiting some, come with a long list drawbacks.
The dangers of weight loss medication supplements came to the forefront a few decades ago with the introduction and subsequent removal of fenfluramine/phentermine (fen-phen) from the weight loss market. While many patients showed excellent results, the risks of taking fen-phen were simply too high and ultimately the drug combination is no longer sold. To this day, memories of fen-phen have colored the medication-based weight loss market.
Advancements in bariatric surgery have yielded an unprecedented number of options for patients looking to improve or eliminate the diseases associated with morbid obesity and lose weight along the way. Each of the many weight loss surgery options present strong benefits and risks. Minimally invasive, non-surgical procedures such as the weight loss balloon may be appropriate for some patients, while a combination malabsorptive and restrictive procedure such as the gastric bypass may be appropriate for others. Following, we will briefly describe the ideal candidate for each procedure, however it is important to remember that the patient’s circumstance and their suitability for one surgery versus another can only be established during a consultation – This is purely a rough guide:
Anyone who has dieted knows that the first phase of weight loss is exciting and far easier than maintaining that weight loss over the long-term. There are both physical and psychological reasons for this phenomenon. The weight loss process after bariatric surgery is no different. Many patients hit the ground running right after surgery and lose a significant amount of weight for the first two years after their procedure. From that point onward, weight loss and weight maintenance become somewhat more difficult and some patients may even begin to regain some of the weight they lost. Indeed, for almost every procedure, five-year excess body weight loss numbers are lower than the two-year figures. Does that mean that, even with bariatric surgery, we are destined for failure? The short answer is no. Let’s explore:
In an effort to give you the most comprehensive answers to common questions and topics, we have updated this blog post which was originally published in 2012. In this update, we will explore the nuances of hernia surgery – about when a patient can reasonably wait to have hernia surgery and alternately when they should have it as soon as possible. Of course, every situation is unique and a consultation with qualified surgeons such as those at ASA is the best first course of action.
There are many types of hernia – inguinal, femoral, incisional, umbilical, hiatal and more – each with their own set of complexities. The one commonality between them is that many of these hernias can start as very minor, causing minimal pain and discomfort. The fact that hernias can seem so benign offers a false sense of security. The thinking is that since there is little or no pain, the hernia is fine and doesn’t need repair.
Every patient is concerned about the risks of gallbladder surgery, but there has also been a good amount of information disseminated to the public that simply does not jive with reality. One of these is the idea is that somehow you will inevitably gain weight after your gallbladder surgery.
There is little definitive data to suggest that all patients that undergo gallbladder surgery will gain weight after their procedure.1,2 And there is no real medical or scientific basis to support this. However, if you have done research online, you’ll likely find many articles and forums dedicated to those who have gained weight after gallbladder surgery. To understand why this weight gain may occur, we need to explore one of the most basic signs and symptoms of gallbladder disease – extreme reactions to certain foods.